Couples are looking for ways to live together at every level of care.
Just like a career or a marriage, how we enter older age is personal: no two experiences of aging are the same. For couples, differing care needs can spark hard choices about how to age together in the same place. Continuing care retirement communities are thinking with residents and families about how to make these choices easier.
Many couples with different care needs live in the same communities but in separate buildings or apartments. For example, one spouse lives in memory care, and another has their own home in independent living. While this kind of arrangement still works well for many couples, the pandemic has led others to rethink the risks. A video of one British couple went viral in 2021 when, after a months-long isolation during which the husband needed medical care, the two were finally reunited at the wife’s assisted living community when he moved in. In different continuing care communities worldwide during COVID, many married couples experienced this kind of separation from each other when units were shut down to visitors.
Even during normal times, the more independent spouse often wants to be more than a visitor, while also not becoming a full-time caregiver. Becoming a care partner for a spouse with Alzheimer’s disease or other conditions can be both rewarding and incredibly difficult. “These are fundamentally individual choices that people need to make,” Dr. Vincent Mor of Brown University’s Center for Gerontology and Healthcare Research told AARP. “If the well spouse is able to and wants to continue to take care of their loved one, that should be their decision.” Communities are starting to offer more ways for the more independent spouse to continue to support their partner, with support.
Continuing care retirement communities (CCRCs), also called Life Plan communities, offer a continuum of care, usually described as:
- Independent living: People 55 and up live in their own homes or apartments, independently or as a couple, with minimal or no assistance. Amenities might include shared meals, activities, common spaces, and transportation.
- Assisted living: Individuals or couples live on their own with some support with activities of daily living in the home.
- Memory care: In a residential setting, people with Alzheimer’s disease or other memory loss have access to the latest therapies and specially trained staff.
- Skilled nursing care: 24/7 care for all medical needs.
Individuals may transition into and out of these different levels of care. For couples, that may mean that one partner may have a stint in skilled nursing while the other remains in assisted or independent living, and then the spouse moves back in after a recovery. This flexibility makes them a good choice for couples looking to maximize their time together.
Most CCRCs have a three-type pay structure:
- Life Care (Type A): Higher upfront fee, but predictable costs even as care needs increase. Sometimes called a lifecare contract.
- Modified (Type B): Some services included, but others cost extra
- Fee-for-Service (Type C): Lower entry cost, but you pay market rates as care needs increase. Sometimes called a fee-for-service contract.
For couples, according to senior living specialist Brad Breeder, there are pros and cons to each choice. If a couple moves into the CCRC together and chooses a Type C contract when they’re both in independent living, then if one spouse needs to move to memory care, for example, the couple will start to pay both a single occupancy rate and for memory care. If they chose Plan A, they’d still be paying the double occupancy rate, but the memory care would be included.
Other fees, of course, may apply–it’s important to read and talk through the contract before committing to one type of payment. Placement specialists can assist with assessing your and your partner’s needs, budget, and preferences to recommend communities and payment options that could be a good fit for both of you.
Questions to Ask
If living together is a priority, when considering different communities, make sure to talk about that priority with staff. Here are some questions to ask.
- Can both partners stay in the same unit with care services brought in for one of them?
- Is there flexibility in meal plans, care staffing, and daily routines to support one partner needing more assistance?
- How does the community and staff support the partner who’s acting as a caregiver for the other?
- Are there additional costs for higher levels of care? How does the pricing structure work?
- What happens if one spouse eventually needs memory care and the other doesn't? How do staff support residents and their families during that transition?
- If one partner dies or moves to a different level of care, can the healthy partner stay in their current unit?
If the couple decide they will live in separate areas of the community but want to maintain as close a connection as possible, ask:
- Are there shared activities both can attend, regardless of ability?
- How often and easily can they visit each other?
- Are there structured programs or staff support to keep them connected, including couples’ counseling or support groups?
- What are your policies for visitors and overnight stays?
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